Wydanie 4/2017
str. 93 - 97

Oczne objawy choroby przeszczep przeciwko gospodarzowi u pacjentów po allotransplantacji macierzystych komórek krwiotwórczych

Ocular Graft-Versus-Host Disease in Patients after Allogeneic Stem Cell Transplantation

Ewelina Serkies-Minuth, Dorota Raczyńska, Leopold Glasner

Katedra i Klinika Okulistyki Gdańskiego Uniwersytetu Medycznego
p.o. kierownika: dr n. med. Leopold Glasner

Summary: Hematopoietic stem cell transplantation is an increasingly used treatment for lymphoproliferative and bone marrow diseases. The most common complication of this therapy is a graft-versus-host disease that causes functional and anatomical disorders with inflammatory etiology in the skin, lungs, gastrointestinal tract, and in the eye. Effective prevention of this disease, based on immunosuppressive treatment, is at risk of relapse of the underlying disease and rejection of the graft. Proper diagnosis and treatment of graft-versus-host disease requires a distinction between acute and chronic disease and the assessment of the severity of organ damage. The ocular changes seen in the acute form of the disease are rash and erythema of the eyelid skin and various conjunctival changes, which are a debilitating factor in the prognosis and a marker of the severity of systemic disease. Dry eye syndrome is the most common complication occurring in patients with chronic graft-versus-host disease. Keratoconjuctivitis sicca may result in complications such as punctuate keratopathy, filamentary keratitis, corneal keratinization and or neovascularization, trophic ulceration and corneal perforation. Treatment of ocular changes requires a multidisciplinary approach and a correct assessment of systemic disease severity. Local therapy, based on non-surgical and surgical methods, is a complement to systemic treatment, particularly important at the time of systemic steroidotherapy reduction. Diagnostic criteria, including assessing the severity of organ damage, and guidelines for the prevention and treatment of graft versus host disease, are subject to modification. The current guidelines for assessment and ophthalmic treatment of graft-versus-host disease in patients after allogeneic hematopoietic stem cell transplantation are presented.

Słowa kluczowe: zespół suchego oka, choroba przeszczep przeciwko gospodarzowi, suche zapalenie rogówki i spojówki.

Keywords: dry eye syndrome, graft-versus-host disease, keratoconjunctivitis sicca.